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On the cover: 

School children 
North Side YWCA 
Chicago, Illinois 


Interim Report of the 
National Commission on 
Children 



OpeningDoon 


for America’s 
Children 



March 31, 1990 


Th e National Commission on Children was established by Public Law 100-203 “to 
seive as a foru m on behalf of the children of the nation. ” It is a bipartisan body whose 
36 members were appointed in equal numbers by the President, the President Pro Tem¬ 
pore of the U.S. Senate, and the Speaker of the U.S. House of Representatives. The Com¬ 
mission is required to submit an in terim report by March 31, 1990 and a final report by 
March 31, 1991 to the President; to the Committee on Finance and the Committee on 
Labor and Human Resources of the Senate; and to the Committees on Ways and Means, 
Education and Labor, and Energy and Commerce of the House of Representatives. 







OPENING DOORS FOR AMERICA’S CHILDREN 


Commission Members 


\c\c\o 


Hon. John D. Rockefeller IV 
U.S. Senator 
State of West Virginia 
Washington, D.C. 

Chairman 

T. Berry Brazelton, M.D. 
Professor of Pediatrics 
Harvard Medical School 
Boston, Massachusetts 

Allan C. Carlson, Ph.D. 
President 

The Rockford Institute 
Rockford, Illinois 

Hon. Bill Clinton 
Governor 
State of Arkansas 
Little Rock, Arkansas 

Hon. Dan Coats 

U. S. Senator 
State of Indiana 
Washington, D.C. 

Donald J. Cohen, M.D. 

Director 

Child Study Center 
School of Medicine, 

Yale University 
New Haven, Connecticut 

Nancy Daly 
Founder 

United Friends of the Children 
Los Angeles, California 

Marian Wright Edelman 
President 

Children’s Defense Fund 
Washington, D.C. 

Hon. Theresa H. Esposito 
Representative 
North Carolina House of 
Representatives 
Raleigh, North Carolina 

Hon. Raymond L. Flynn 
Mayor 

City of Boston 
Boston, Massachusetts 

Mary Hatwood Futrell 
Senior Fellow 
Center for Education 

and National Development 
George Washington University 
Washington, D.C. 


Hon. Martha W. Griffiths 
Lieutenant Governor 
State of Michigan 
Lansing, Michigan 

Adele Hall 

Member, Board of Directors 
Children’s Mercy Hospital 
Shawnee Mission, Kansas 

Irving B. Harris 
Chairman of the Executive 
Committee 
Pittway Corporation 
Chicago, Illinois 

Betty Jo Hay 
Former President 
National Mental Health 
Association 
Dallas, Texas 

Hon. Bill Honig 
Superintendent of Public 
Instruction 
State of California 
Sacramento, California 

Wade F. Horn, Ph.D. 
Commissioner 
Administration for Children, 
Youth and Families 
U.S. Department of Health and 
Human Services 
Washington, D.C. 

Mai Bell Hurley 
Former President 
Child Welfare League of 
America 

Chattanooga, Tennessee 

Hon. Kay C. James 
Assistant Secretary for Public 
Affairs 

U.S. Department of Health and 
Human Services 
Washington, D.C. 

A. Sidney Johnson, III 
Executive Director 
American Public Welfare 
Association 
Washington, D.C. 

Ruth Massinga 
Chief Executive Officer 
Casey Family Program 
Seattle, Washington 


Gerald W. McEntee 
President 

American Federation of State, 
County and Municipal 
Employees, AFL-CIO 
Washington, D.C. 

Hon. George Miller 
U.S. Congressman 
State of California 
Washington, D.C. 

James D. Northway, M.D. 
President and CEO 
Valley Children’s Hospital 
Fresno, California 

A. Louise Oliver 
Former Special Assistant and 
Consultant 

U.S. Department of Education 
Washington, D.C. 

Gerald (Jerry) P. Regier 
Acting Director 
Bureau ofjustice Assistance 
U.S. Department ofjustice 
Washington, D.C. 

Hon. Nancy Risque Rohrbach 
Government Relations 
Consultant 
Washington, D.C. 

Sarah Cardwell Shuptrine 
President 

Shuptrine and Associates 
Columbia, South Carolina 

Josev M. Velazquez 
Executive Vice President 
Hands in Action 
Miami, Florida 

Hon. Lowell P. Weicker,Jr. 
President and CEO 
Research! America 
Alexandria, Virginia 

David P. Weikart, Ph.D. 
President 

High/Scope Educational 
Research Foundation 
Ypsilanti, Michigan 

Bernice Weissbourd 
President 
Family Focus 
Evanston, Illinois 


Robert L. Woodson 
President 

National Center for 

Neighborhood Enterprise 
Washington, D.C. 

Barry S. Zuckerman, M.D. 
Director 

Division of Developmental 
and Behavioral Pediatrics 
Boston City Hospital 
Boston, Massachusetts 

David Zwiebel.J.D. 

General Counsel and Director, 
Office of Government Affairs 
Agudath Israel of America 
New York, New York 


Staff 


Cheryl D. Hayes 
Executive Director 

Carol A. Emig 
Deputy Director 

Renee Wessels 
Communications Director 

Joseph A. Cislowski 
Policy Analyst 

Tamara L. Horne 
Policy Analyst 

Deborah A. Roderick 
Policy Analyst 

Marian Rodriguez 
Policy Analyst 

Jeannine M. Atalay 
Administrative Officer 

LindaJ. Wells 
Executive Assistant 

Mary Lou Rinehart 
Administrative Assistant 


Photography by Eric H. Futran 








2 







Dear Friends and Colleagues, 

One of the tragic ironies of recent decades is that in a period of significant economic 
growth, the most prosperous nation on earth seems to be failing its children. The 
evidence of this failure is pervasive. In 1990, children are the poorest group in U.S. 
society. More than one in five lives in a family whose income is below the poverty level. 
Every night an estimated 100,000 children or more go to sleep homeless. Malnutrition 
affects nearly a half million. Despite a generation of medical advances, each day more 
than 100 American babies die before their first birthday. Each year approximately one 
million teenage girls become pregnant; and many have babies they are unable to nurture 
or support. Nearly a quarter of our students experience academic failure and drop out 
before completing high school. Countless others who graduate lack the basic skills 
necessary to obtain an entry level job. 

The litany of facts and trends has become all too familiar. It is often recited, but too 
rarely followed up by action. The seriousness of the problems afflicting manv of the 
nation's children and their families is now largely beyond debate. In some cases, effective 
solutions alreadv exist in formal programs and informal arrangements but fail to reach 
all those in need. In other cases, new conditions challenge established approaches; while 
in still others, there is little consensus about what should be done. 








The National Commission on Children was created by Congress and the President 
to “serve as a forum on behalf of the children of the nation.” Its establishment reflects 
a growing public concern and renewed political will to place children at the top of the 
national agenda. Over its two-year life, the Commission will travel the country to hear 
from parents, professionals, and children themselves. Our mission is to assess the status 
of children in the United States and propose new directions for policies and programs. 
My hope is that we will craft a bold agenda for public and private sector action in the 1990s 
and build the necessary public commitment to see it implemented. 

Members of the Commission come from many walks of life and represent an array of 
viewpoints, professional affiliations, and political perspectives. We have been moved by 
the courage and concern of the parents and children we have met, and inspired and 
humbled by the professionals and volunteers who work every day with children and their 
families. Yet we have been troubled by much of what we have learned about the current 
conditions and future prospects of many American children. 

This interim report shares some of what we have seen and heard in our hearings, 
town meetings, site visits, and forums in communities across the country. It also reviews 
the framework that guides our activities and discusses several of the salient themes and 
issues that have emerged. Because we are only midway through our inquiry, it is 
premature for the Commission to offer specific recommendations. Therefore, this 
report presents a brief summary of our progress to date. While members of the 
Commission have had a significant hand in shaping this document, they have not been 
asked to vote on specific language. 

In the coming year, the Commission will complete its investigation and delibera¬ 
tions. On March 31, 1991, we will report to Congress and the President. When we began 
nearlv a year ago, it was our hope to produce realistic and far-reaching proposals to 
benefit America's children. Today, we are well on our way to doing so. 


Sincerely, 



John D. Rockefeller IV 


Chairman 











OPENING DOORS FOR AMERICA’S CHILDREN 


Contents 


Children, Families, and the Nation: Adapting to New Realities 7 

A Forum for the Nation’s Children 11 

A Developmental Framework 13 

Assessing the Status of America’s Children 13 

Field Hearings 15 

Public Town Meetings 15 

Site Visits 15 

Forums and Focus Groups 16 

National Opinion Research Project 17 

Corporate Advisory Board 17 

Activities to Date: A Progress Report 19 

Healthy Mothers and Healthy Babies, Chicago, Illinois 19 

Children and Families in Rural America 21 

Part I: The Midwest, Madison, Indiana 
Part II: The South, Bennettsville, South Carolina 


Enhancing School Readiness: Support for Early Childhood Development, 


San Antonio, Texas 24 

America’s Children and the Drug Crisis, Kansas City, Missouri 26 

Making Ends Meet: American Families and the Economy, 

Charleston, West Virginia 28 

Emerging Themes and Issues 31 

The Critical Role of Parents and Other Caring Adults 31 

Children in Poverty 33 

The Pervasiveness of Drugs 35 

The Crisis in Health Care 37 

The Need for School Readiness 39 

Reorienting Services for Children: A Focus on Coordination and Prevention 42 

Opening Doors in the 1990s 45 

Appendix: Commission Activities, September 1989 - March 1990 47 

Schedule of Activities 48 


5 














OPENING DOORS FOR AMERICA’S CHILDREN 


Children, Families, and the Nation: 
Adapting to New Realities 


# he experience of growing up in the United States today is very different 
JL than it was just a generation ago. Sweeping social and economic changes 
since the 1960s have fundamentally altered the form of many American families, 
the way they live, and the world in which they raise their children. Changing 
patterns of marriage and family formation, the dramatic entry of women into the 
paid labor force, and the declining economic status of many families with child¬ 
ren have been widely reported and analyzed. 

Behind the statistics are real parents and real children. At every income level, 
in all racial and ethnic groups, and in every region of the country, these changes 
have challenged the routines, traditions, and family values of generations of 
Americans. For the nation, they raise important and often troubling questions 
about the health and well-being of this and future generations of children and the 
capability and commitment of their parents to care for and nurture them. 

Today, children are the poorest group in America. Nationwide, one in five 
children is poor. In many cities and rural communities, the proportion is even 
greater. While the causes of childhood poverty are complex and difficult to 
disentangle, the consequences are painfully clear. From infant mortality and 
unmet health needs, to school failure and lifetimes of limited opportunity, the 
personal and societal costs are enormous, and they are rising. 

At a time of great national prosperity, many families have both parents in the 
workforce in order to maintain a standard of living that earlier generations 
^ attained with just one income. For the record number of families with only one 

parent — almost always a mother — even a modest middle-class life is frequently 
DAUGHTER beyond reach. As more mothers enter the workforce, more children than ever 

CHICAGO, Illinois before spend a significant portion of their time in the care of adults other than 

their parents, or they are left alone without adult supervision. And more parents 
worry that by working to meet their children’s economic needs, they may in some 
way shortchange their children’s social and emotional needs. 

In the nation’s cities, drugs poison our playgrounds and classrooms. A small 
but growing number of children enter the world with their futures already 
compromised by their mothers’ use of alcohol and drugs, while others watch 
helplessly as substance abuse destroys the adults upon whom they depend. For 
youngsters who live amid the crime and violence spawned by drugs and poverty, 
childhood is a time of fear, anger, and frustration. 





In the workplace, technology and global competition demand an American 
labor force with sophisticated skills and problem-solving abilities. In the voting 
booth, subtle and complex issues call for thoughtful and knowledgeable citizens. 
Yet public opinion suggests that many Amiericans have little confidence in the 
ability of the educational system to prepare students to fill the jobs of tomorrow 
and to share in the privileges and responsibilities of citizenship. 

The realities of childhood and family life in the last decades of the twentieth 
century raise serious questions about the reach and effectiveness of existing public 
and private sector policies and programs to support children and their families. 
Policymakers, professionals, and parents alike express two related concerns. The 
first is that many of our young people are reaching adulthood unhealthy, illiterate, 
unemployable, and without moral direction. Many bear babies they are unable to 
rear and support, without a vision of a secure future, and at risk of entering a 
continuing cycle of poverty and dependency. Second, and equally troubling, is 
that some existing strategies to prevent and ameliorate these problems fail to 
reach many of the children and families who need them most, and others may not 
fully reflect recent changes in childhood and family life. Still others may uninten¬ 
tionally weaken parents’ autonomy and sense of responsibility for their children. 


Head Start student 
La Casa de Ninos 
Child Development 
Center 

San Antonio, Texas 


8 




OPENING DOORS FOR AMERICA’S CHILDREN 


Throughout the nation, there is also growing recognition that if the United 
States is to remain a competitive economy and a democratic nation, all sectors 
of society must appreciate the importance of our children — as future citizens, 
parents, employees, and taxpayers. As we enter the 21st century, we can ill 
afford to waste our human resources. To do so will impoverish our nation — 
culturally, politically, and economically. America’s economic interests and its 
traditional values combine to provide a powerful rationale for public and pri¬ 
vate sector action. 

This confluence of interests and values joins with agrowing body of knowledge 
from scientific research, program experience, and best professional practice. It 
leads to a broader vision and a new commitment to improve the life prospects of 
all American children, and it points to promising directions for new initiatives and 
needed improvements to existing policies and programs. The result is an emerg¬ 
ing consensus across the political spectrum: the time has come to find new ways 
to ensure that the doors of opportunity are open for all of America’s children. 


Student 

Deputy Elementary 
School 

Deputy, Indiana 



9 














OPENING DOORS FOR AMERICA’S CHILDREN 


A Forum for the Nation’s Children 


Young children 
Rockwell Gardens 

HOUSING COMPLEX 

Chicago, Illinois 


T he convergence of knowledge, need, and concern about the health and 
well-being of America’s children led Congress and the President to estab¬ 
lish the National Commission on Children to serve as “a forum on behalf of the 
children of the nation.” Members of the Commission, appointed in equal num¬ 
bers by the President Pro Tempore of the Senate, the Speaker of the House of Rep¬ 
resentatives, and the President, bring a spectrum of political and professional per¬ 
spectives and expertise. Almost all are parents, and some are grandparents. 

The goal of the National Commission on Children is to propose policy 
directions to improve opportunities for all American children to reach their 
full potential and to enhance the capacity of their families to care for and nur¬ 
ture them. 

Several fundamental assumptions underlie this goal: 

♦ Every child, regardless of social, economic, and cultural circumstances, 
should have the opportunity to become a healthy, literate, secure, ecomomically 
self-sufficient, and productive adult. 

♦ Families are and should remain the central locus for childrearing. Parents 
have the natural and primary responsibility for the care and nurturing of their 
children. Social institutions, including schools, churches, community organiza¬ 
tions — as well as government — should supplement and strengthen the role of 
the family. 

♦ The problems and conditions that threaten the health and well-being of 
American children and families have evolved over time. Like other complex and 
difficult issues, they will not yield to easy answers or quick fixes. 

♦ Solutions will take root and produce results only after sustained effort. 
They will certainly include an array of policies, programs and approaches 
sensitive to the strengths and values of a diverse nation and to the developmental 
needs of children and families at different stages in the life span. 

♦ Responsibility for improving the current conditions and future prospects 
of America’s children should be widely shared among individuals, families, 
communities, employers, the voluntary sector, and government at all levels. 
Society’s commitment to its families and their children must be significant and 
broad-based. 


11 




OPENING DOORS FOR AMERICA’S CHILDREN 


Best friends 
Deputy, Indiana 


In fulfilling its mandate, the National Commission on Children has six basic 
objectives: 

♦ To review and assess the status of American children and their families. 

♦ To heighten the nation’s awareness and understanding of the problems 
threatening many American children and their families and society’s common 
stake in finding effective solutions. 

♦ To set ambitious goals for improvement in the health and well-being of 
children and their families by the year 2000. 

♦ To propose priorities for public and private sector policies toward children 
and their families during the 1990s. 

♦ To identify key strategic steps toward the development and implementa¬ 
tion of effective policies and programs. 

♦ To build a broad and strong base of support in all sectors of society for 
action to enhance the current conditions and future prospects of children 
and their families. 





OPENING DOORS FOR AMERICA’S CHILDREN 


A Developmental Framework 

/ n order to look beyond the existing patchwork of policies and programs and 
to identify fresh approaches to improve the health and well-being of Ameri¬ 
can children and their families, the Commission adopted a conceptual framework 
for its work based on the process of growth and change that constitutes child 
development. Instead of focusing exclusively on existing legislative and adminis¬ 
trative structures, the Commission chose to broaden its purview to include 
fundamental issues concerning children’s characteristics and experiences, family 
roles and relationships, community structures and supports, and the interactions 
among them that significantly influence child outcomes. 

Children’s genetic endowment combined with their accumulated life expe¬ 
riences determine the persons they will become. To grow into healthy, compe¬ 
tent, and productive adult members of society, children must have their basic 
health and nutritional needs met. They must acquire the basic skills of modern 
life. They must develop a sense of moral direction. They need to become socially 
competent. They must possess a secure and positive sense of themselves and their 
place in the world. They must become literate, thinking individuals who can solve 
problems and communicate with one another. 

Development is the continuing process by which children come to under¬ 
stand the world, to find their place in it, and to set their course through it. 
For youngsters who perceive the world as hostile and themselves as helpless to 
take charge of their environment, development is often restricted. Many of these 
children will fail to grow into confident, competent, and productive adults. If, 
on the other hand, they feel secure and their basic developmental needs are 
met, most children will gain the necessary skills, confidence, direction, and 
social responsibility to become active citizens, productive employees, and nur¬ 
turing parents. 

This process occurs first and foremost within families, where parents are their 
children’s most important teachers and caregivers. Parents have the primary 
responsibility to provide for their children, to give them a sense of security and 
direction that is the firm foundation for future growth and development. 

.Although the family is the central locus for child development, it does not 
function in isolation. Other individuals, formal and informal networks of support, 
schools, religious institutions, the workplace, and government all play a role in the 
daily lives of parents and children. They can strengthen families’ ability to nurture 
and educate their children — or they can weaken it. 

Ideally, all children would be born into strong families with the resources to 
meet their basic social, emotional, cognitive, and physical needs. They would live 


13 



Sleeping baby 
Capital High 
School Child 
Care Center 
Charleston, 
West Virginia 


in safe and secure neighborhoods and communities that support and reinforce 
the ability of families to rear children. Unfortunately, however, for too many 
children in the United States today, this is not the case. Many families, especially 
those living in dangerous and destructive environments, need help to protect their 
children against adverse outcomes and to ensure that they attain the essential 
components of healthy growth and development. 

In some cases, informal networks of support exist in extended families, 
cultural groups, and communities to augment the natural strengths of families. 
Formal interventions — ranging from preventive programs to crisis intervention 
— seek to supplement informal systems and strengthen individual families. They 
include an array of programs and clinical approaches, supported and operated by 
public and private health, education, and social welfare agencies, both large and 
small, as well as voluntary organizations. 

Even the best programs and services cannot inoculate children against 
failures. But in many cases, they can help children take advantage of opportuni¬ 
ties that will present themselves later in school, in work, and in personal rela¬ 
tionships. Moreover, they can help families support their children’s development 
and overcome the conditions and circumstances of life that threaten health and 
well-being. 





OPENING DOORS FOR AMERICA'S CHILDREN 


Assessing the Status of America’s Children 

i-J rom September 1989 to September 1990, the National Commission on 
JL Children is undertaking a series of activities to assemble, integrate, and 
review information on the status of America’s children and their families. The 
Commission's activities will culminate in proposals for public and private sector 
action on behalf of the nation’s children, to be presented to Congress, the 
President, and the American people by March 31, 1991. 

The Commission’s major public activities include: 

Field Hearings 

The Commission is convening seven public hearings on specific topics in 
urban and rural communities across the country. At these hearings, members of 
the Commission receive testimony and question expert witnesses on the status of 
children and their families, the effects and effectiveness of formal and informal 
initiatives by the public and private sectors to address their needs, the require¬ 
ments for effective program implementation, and recommendations for policy 
development. Witnesses are invited from across the country and include an array 
of public and private sector decision makers, scholarly and professional experts, 
program and service providers, and corporate and labor leaders, as well as parents 
and children themselves. 

Public Town Meetings 

The Commission is convening three town meetings in selected communities 
across the country so that Commissioners can solicit the views of a wide spectrum 
of citizens in an open and relatively unstructured public exchange. Town meet¬ 
ings focus on broad topics of public concern, such as substance abuse, or on 
specific populations of children, such as children in rural communities. In 
particular, they are effective mechanisms for encouraging parental input into the 
work of the Commission, and they are useful barometers of public awareness and 
concern about a range of issues affecting children and families. 

Site Visits 

Field hearings and town meetings are combined with site visits to relevant 
programs, institutions, and organizations providing supports and services to 
children and their families in a variety of settings. Site visits allow Commissioners 
to see firsthand the circumstances in which some children live and are raised, to 


15 



Teenager speaks out 

AT STUDENT FORUM 

Kansas City, 
Missouri 


observe service delivery to children and their families, to see model programs in 
action, and to have extended discussions with service providers and with partici¬ 
pating parents and children. Site visits are chosen to illustrate and underscore the 
major issues addressed in a particular hearing or town meeting. 

Forums and Focus Groups 

The Commission is also convening a series of forums and focus groups in 
conjunction with its hearings and town meetings. These focused discussions allow 
Commissioners to explore special issues of concern — for example, the presence 
of drugs in schools and communities, the quality' of life in small towns and rural 
communities, and the special challenges of making ends meet in a changing 
economy — with groups of adults including religious leaders, teachers, and par¬ 
ents, as well as with children and teenagers. 




OPENING DOORS FOR AMERICA'S CHILDREN 


National Opinion Research Project 

To supplement the scholarly knowledge, professional perspectives, and per¬ 
sonal insights presented in the hearings, town meetings, site visits, forums, and 
focus groups, the Commission is conducting opinion surveys to generate nation¬ 
ally representative data on the attitudes and perceptions of children, parents, and 
the general adult population. These surveys will explore how children and adults 
view the major social, economic, and demographic changes that have affected 
family life in recent decades, as well as their perspectives on future prospects for 
children. This, in turn, will help the Commission frame the major issues affecting 
children’s health and well-being in the most immediate and compelling manner 
and identify the leverage points around which broad political consensus can 
develop. The survey results will be released publicly in late 1990. In addition, the 
Commission will place all data in the public domain, so that it can contribute to 
the ongoing work of child and family scholars and researchers. 

Corporate Advisory Board 

Confronting the challenges facing children and families in the United States 
will require the concerted efforts of Americans from all walks of life and from all 
sectors of society. The business community has a significant economic stake in the 
quality of the workforce and the productivity of American industry. Corporate 
leaders can play a pacesetting role in raising awareness of the need to improve 
the skills and preparedness of the future labor force and in bringing the worlds 
of work and family life closer together. Accordingly, the National Commission on 
Children — charged with developing private as well as public sector proposals to 
advance the health and well-being of children and their families — is establish¬ 
ing a Corporate Advisory Board to be chaired by Mr. William Woodside, Chairman 
of Sky Chefs, Inc., and Vice Chairman of the Committee for Economic Develop¬ 
ment. This board, composed of corporate leaders from an array of industries and 
firms nationwide, will provide timely input into the Commission’s deliberations. 
It also will be a critical sounding board for private sector proposals and for 
corporate support for public sector proposals. 


17 






OPENING DOORS FOR AMERICA’S CHILDREN 


Activities to Date: A Progress Report 


Lj rom September 1989 through March 1990, members of the National Com- 
-X. mission on Children traveled to six communities across the country, where 
they held three hearings, three town meetings, nine site visits, and five forums and 
focus groups. In every community, the Commission encountered widespread 
support for its mission, evidenced in consistently large turnouts for its hearings 
and town meetings and extensive media attention to the issues raised. In 
particular, the Commission’s town meetings, where citizens were encouraged to 
speak out, tapped deep and widespread public concern for children. Each town 
meeting was marked by large and diverse crowds of parents, children, teachers, 
and other professionals who work with children, as well as a broad cross-section 
of community residents. Many at the town meetings rose to share their worries, 
fears, and aspirations for the children of the nation, as well as their suggestions 
for how to strengthen family life and improve prospects for all children. 

Descriptions follow of the Commission’s activities in each of the communi¬ 
ties it visited. Hearing witnesses, programs visited, and groups participating in 
forums and focus groups are listed in the Appendix. 


Healthy Mothers and Healthy Babies 


Chicago, Illinois 
September 25 , 1989 


Young patient 
Neonatal Intensive 
Care Unit 
Cook County 
Hospital 
Chicago, Illinois 


C hildren grow and learn from the moment they are born. In the first three 
years of life, they acquire the fundamental building blocks of physical, 
emotional, social, and intellectual development. A child’s earliest experiences 
can provide a solid foundation for later physical health, emotional well-being, 
loving human relationships, and productive achievement. 

Most babies in the United States are born healthy and grow into able and 
productive adults. Some, however, are born too soon, too small, and with serious 
health problems that place them at heightened risk of dying before their first 
birthday and leave them vulnerable to lifelong disability. 

Poor birth outcomes pose high human and financial costs for children, their 
families, and society'. Nearly seven of every 100 babies are born at low birthweight 
(less than 5.5 pounds). Low birthweight babies are 20 times more likely than those 
of normal birthweight to die during infancy. They are also more likely to grow up 
with long-term disabilities and to suffer illness and injuries that severely compro¬ 
mise their physical ability and intellectual growth and development. Low birth¬ 
weight babies are two to three times as likely as normal birthweight infants to have 





OPENING DOORS FOR AMERICA’S CHILDREN 


handicapping conditions such as chronic lung problems, cerebral palsy, epilepsy, 
blindness, hearing impairment, and mental retardation. 

While several factors contribute to the developmental problems that threaten 
many of our youngest citizens, the most pervasive is poverty. For those born to 
mothers who have used drugs and alcohol during their pregnancies and those 
infected with the AIDS virus, the risk of irreparable harm is even greater. 

Over the past decade, a growing body of scientific research and program 
experience has increased knowledge of how to prevent damage to young children 
and how to give them a good start in life. Prenatal care, adequate nutrition, 
immunization, early education, family support, safe and secure homes and neigh¬ 
borhoods, and strong social networks are a few of the important ingredients. 
Where families and society have made the necessary financial, political, and moral 
commitment to healthy mothers and healthy babies, there has been dramatic 
progress in reducing infant mortality and the developmental casualties of early 
life. Despite medical advances, however, the pace of improvement has slowed, and 
in some cases reversed itself. More than 30 percent of pregnant mothers receive 
inadequate prenatal care. Almost 40,000 babies born in the United States each 
year die before their first birthday. And millions of children fail to receive routine 
immunizations that can protect them against preventable diseases such as polio, 
measles, and mumps. 

The growing scourge of drugs poses a significant new challenge to the goal of 
giving all children a healthy start in life. Drug treatment programs are scarce in 
most communities and often turn away expectant mothers whose pregnancies 
pose special risks. Large urban hospitals bear the human and financial burdens 
of caring for infants who begin life already severely compromised by maternal 
substance abuse. Child welfare systems in cities across the country are over¬ 
whelmed by the rapidly rising number of babies abandoned in hospitals at birth 
and by abused and neglected children in need of care and protective services. 
Schools face the difficult job of teaching youngsters who enter the classroom with 
serious learning and behavior problems directly attributable to their parents’ drug 
and alcohol use. 

The National Commission on Children traveled to Chicago, Illinois to exam¬ 
ine issues related to health and development in the prenatal period and the first 
three years of life. Commissioners visited the neonatal intensive care unit at Cook 
County Hospital for a firsthand look at the consequences of inadequate prenatal 
care and maternal substance abuse. They also traveled to some of Chicago’s 
poorest neighborhoods to observe community-based programs serving expectant 
and new parents and their children. At each stop, they heard from parents and 
staff about limited access to prenatal care and the difficulties of raising children 






OPENING DOORS FOR AMERICA'S CHILDREN 


amid the crime and violence endemic to many inner-city neighborhoods. They 
also saw the effects of intensive family support and parent education services. 

Following these site visits, the Commission held its first public hearing, on 
“Healthy Mothers and Healthy Babies.” Among those presenting testimony were 
public health and hospital directors struggling to cope with rising infant mortality, 
low birthweight, and the growing number of drug-addicted and .AIDS-infected 
infants; national experts on the design and delivery of prenatal services and on 
early childhood development; representatives of human service organizations 
providing early and comprehensive prenatal care and family support; and parents 
raising children in low-income housing projects. 


Children and F.amilies in Rural America 


Part 1: The Midwest 
Madison, Indiana 
October 12, 1989 


Part II: The South 
Bennettsville, 
South Carolina 
February 15, 1990 


M any of this country’s oldest, richest, and strongest traditions have their 
roots in .America’s small towns and rural communities, where close-knit 
families, supportive communities, and belief in the rewards of hard work and self- 
reliance remain strong. Traditional values continue to play a central role in family 
and community life. 

Many recent indicators of child health and well-being in rural .America, 
however, are troubling. Years of improvement in maternal and child health have 
reversed in the last decade, reflecting the combined effects of poor economic 
conditions, the difficulties of attracting health professionals to isolated areas, and 
cutbacks in some federal health programs. Many rural school children lag behind 
their urban and suburban counterparts on national achievement tests and in 
college completion rates. A significant proportion of rural youth fail to finish 
high school. While juvenile delinquency and substance abuse are less prevalent 
in rural communities than in metropolitan areas, they are increasing at a faster 
rate. And teen birth rates in many rural areas continue to exceed rates in 
metropolitan areas. 

Despite the prevailing stereotype of poverty as an inner-city phenomenon, 
one of every four poor Americans lives in a rural area, and one of every four rural 
children is poor. These children frequently escape public attention because they 
live in families in which at least one parent works, and because rural families are 
less likely than urban families to rely on public assistance. Rural poverty' is not 
limited to any one racial or ethnic group. But it is extensive and persistent in 
minority' communities, especially among southern blacks, Native .Americans, and 
the families of black and Hispanic migrant workers nationwide. 








fl pin 



n 









wT s* ’ \ j 






1 i 
1 

if i 


Present economic trends in rural America do not promise an easy or secure future 
for the children and families who live in these areas. Farming, the traditional mainstay 
of the rural economy, today employs fewer than one in ten rural workers. The 40 
INDIANA percent of rural workers employed in manufacturing also face uncertainty as plant 

closings and downsizings continue to create problems in communities whose eco¬ 
nomic fortunes are tied to a few major employers. 

At a time when the nation’s future workforce needs to be highly skilled and 
literate, many rural communities are struggling to support and upgrade their 
educational systems. The same isolation that discourages health professionals from 
settling in rural communities often prevents teachers from pursuing careers in rural 
schools. An eroding tax base only intensifies the difficulties associated with delivering 
quality education. Already, a significant number of young and well-educated rural 
citizens are migrating to cities and suburbs. If this trend continues, it can only make 
it more difficult for rural communities to attract new, high-tech industries. 

In many respects, rural America today is at a crossroads, and prospects for rural 
children and their families — regardless of income — are uncertain. The economic 
changes of recent decades may prove to be the catalyst for dramatic improvements 
in health care, education, and social services, or may leave present and future gen- 


22 











OPENING DOORS FOR AMERICA’S CHILDREN 


erations of rural children with fewer opportunities than earlier generations or 
than their counterparts in metropolitan America. 

To explore these issues, the National Commission on Children held two town 
meetings on “Children and Families in Rural xAmerica." The first, held in Madi¬ 
son, Indiana, was attended by more than 500 parents, children, teachers, and 
other citizens. The second, held in Bennettsville, South Carolina, drew almost 
1,000 people. 

In each of these meetings, Commissioners heard a great deal that was 
heartening, as citizens expressed pride in their communities and reaffirmed the 
fundamental value of strong, close families. But many who spoke out also ex¬ 
pressed concern and frustration about forces they believe threaten the security of 
their communities and the future of their children and families — growing moral 
confusion, economic uncertainty, the increasing role of government in their 
private lives, and the lack of access to needed services. In Madison and in 
Bennettsville, many working families had no health insurance. Access to health 
care was further limited by the small number of providers and the distances that 
many families must travel to see a doctor or get to a hospital. Teachers and students 
alike expressed frustration over the limits of the educational system. Parents 
worried about their ability to make ends meet in a fragile economy. And young 
people expressed their intentions to seek economic opportunities beyond their 
hometowns. 

In Madison, adults and young people who participated in the town meeting 
expressed concern about the encroachment of urban problems such as juvenile 
drug use and delinquency. They worried about the growing number of children 
left on their own during non-school hours. And they asserted the central role and 
responsibility of parents in providing care and direction for their children. 

In Bennettsville, Commissioners also explored some of the challenges facing 
rural children and their families in a series of small group discussions. Black 
ministers spoke movingly of the time pressures on two-earner families with 
children, declining moral values, and the paucity' of recreational opportunities for 
young people. Health care providers shared their perspectives on the failing 
system of care for pregnant mothers and children. State officials identified the 
difficulties of federal-state cooperation as well as the challenges and potential 
rewards of interagency coordination among health and human services. High 
school honor students shared their hopes and and plans for the future, while 
young men detained in a maximum security prison told of their own often 
troubled childhoods, their broken families, and their limited hopes for the future. 


23 



OPENING DOORS FOR AMERICA’S CHILDREN 


Enhancing School Readiness: 
Support for Early Childhood 
Development 


San Antonio, Texas 
November 27 - 28, 1989 


# he early childhood years (ages three to six) are a crucial period of human 
JL development. A child’s experiences during these years significantly affect 
later school success. Research indicates that children whose basic needs for health 
care, adequate nutrition, a safe environment, loving caregivers, and appropriate 
developmental stimulation are met are more likely to complete high school, 
attend college, and secure jobs. In contrast, children who are at risk during this 
period, due to poor health, an unsafe environment, lack of parental attention and 
nurturing, or inadequate or inappropriate stimulation, often experience serious 
developmental problems. They are at higher risk of early academic failure, and 
many drop out before completing high school. As a consequence, they often fare 
poorly in the job market and fail to become economically self-sufficient. 

Unfortunately, the basic health and developmental needs of many American 
children are not being adequately met at home or in the other settings where they 
receive care. In particular, children raised in poverty, children with disabilities, 
children whose first language is not English, and children from highly stressed or 
disorganized families often do not begin school as ready as their more advantaged 
classmates. As a consequence, they are at increased risk of school failure. 

Many young children are still cared for solely by their parents — by mothers 
or fathers who are not in the labor force and by parents who juggle their work 
schedules in order to care for their children themselves. Yet the growing partici¬ 
pation of mothers in the paid labor force over the past two decades has meant that 
more and more youngsters are in the care of adults other than their parents, and 
many are in group programs in out-of-home settings. Over time, a diverse array of 
early childhood programs has developed. These vary from informal arrangements 
in the homes of relatives and neighbors to more formal programs in schools, 
churches, and child care centers. Some are primarily custodial, while others stress 
educational enrichment. The diversity of these programs reflects varied demand 
and ability to pay for services among families in different social, economic, and 
cultural circumstances. On the one hand, this diversity gives parents a wide array 
of options from which to choose. On the other hand, it raises concern over the 
extent to which such an uncoordinated system meets the developmental needs of 
all the young children it serves. 

A growing body of scientific research on the developmental effects of early 
intervention indicates that many youngsters, especially those from low-income 
families, benefit from early childhood programs. However, the benefits of a 


24 




Preschoolers 
Capital High 
School Child 
Care Center 
Charleston, 
West Virginia 



program depend primarily on its quality, and quality varies dramatically from 
program to program and provider to provider. Unfortunately, not all families have 
access to the tvpe of care they seek at a price they are able or willing to pay, and 
not all young children in out-of-home care are in quality’ programs. In particular, 
children who are at greatest risk of educational failure — those from economi¬ 
cally disadvantaged and highlv-stressed families — are the least likely to be in high 
quality early childhood programs. Many families, especially those who are poor 
and those whose children have special needs, fall through the cracks. They 
frequently lack access to affordable, developmentally appropriate child care and 
child development services. And even where these programs exist, some parents 
lack the time, knowledge, and financial resources required to locate and secure 
a place for their children. 

Once strictly a private family matter, child care and early childhood educa¬ 
tion have become topics of heated public debate. At the national, state, and local 
levels, policymakers, professionals, and parents express strongly held views on 
how and to what extent government and the private sector should be involved in 
the development, design, and financing of early childhood programs — and 
which families should have priority in the distribution of scarce public resources. 

In a San Aitonio, Texas hearing on “Enhancing School Readiness,” the 
National Commission on Children explored issues concerning the availability, 




OPENING DOORS FOR AMERICA'S CHILDREN 


America’s Children 

and the Drug Crisis 

affordability, and quality of early childhood programs, as well as the feasible and 
appropriate roles of government and the private sector in enhancing the ability 
of families, regardless of care arrangements, to provide for their young children’s 
healthy development. Witnesses included early childhood scholars and research¬ 
ers, individuals responsible for the design and administration of state and munici¬ 
pal early childhood programs, corporate leaders, and parents. 

In San Antonio, Commissioners visited programs serving Hispanic children 
and families, the nation’s fastest growing minority population. They visited an 
innovative public school in one of the poorest school districts in Texas, where they 
observed a bilingual kindergarten class, a preschool program for children with 
physical and mental disabilities, and an English class for Spanish-speaking par¬ 
ents. Commissioners also observed a full-day Head Start program providing com¬ 
prehensive child development and child care services to low-income families. 

Kansas City, Missouri 

] ational polls indicate that Americans perceive the drug crisis as the most 

December 11, 1989 

1 \ significant threat to our nation’s well-being. Although casual substance 

use among middle-class youth actually declined somewhat in the 1980s, use and 
abuse among low-income youth have escalated. As a consequence, drugs and 
alcohol severely compromise the health and safety of many American children 
and their families. Use by pregnant mothers impairs the health and threatens the 
long-term development of their children. Increasing rates of child abuse and 
neglect are frequently attributable to parents’ substance use. Drug-related 
emergency room episodes are skyrocketing, and drug use is responsible for 
thousands of transmissions of the deadly AIDS virus. Moreover, the incidence of 
drug-related deaths has increased sharply in the past several years as inner-city 
neighborhoods across the nation have been devastated by the crime and violence 
associated with a thriving drug trade. 

Programmatic experience, while limited, includes prevention efforts, treat¬ 
ment programs, and law enforcement activities. A variety of substance abuse 
education and prevention programs for elementary and secondary students are 
being tested and evaluated in schools and communities across the country. 
Health and social service professionals struggle to design, implement, and main¬ 
tain stable funding for treatment programs for different populations of addicts, 
including teenagers and expectant mothers, while public officials, employers, 
and insurers search for reasonable financing mechanisms. At the same time, law 
enforcement officials battle to decrease the supply of illicit drugs at our national 
borders and on our city streets. 




Teenager in a 

DRUG REHABILITATION 
PROGRAM 

Adolescent Center 
for Treatment 
Olathe, Kansas 



4 £ 


- w 




i i 

jihf 


The National Commission on Children traveled to the Kansas City metropolitan 
area to consider issues concerning the effects of the drug crisis on American 
children and their families. Commissioners visited the school district of Inde¬ 
pendence, Missouri, where a comprehensive program to prevent drug and 
alcohol use and to promote children’s health and well-being is underway, sup¬ 
plemented by a unique insurance plan to finance substance abuse treatment. 
They also met with teenagers in the Johnson County Adolescent Center for 
Treatment, a residential drug treatment program in Olathe, Kansas. In a forum 
with inner-city high school students from Kansas City 7 , Missouri, Commissioners 
heard firsthand the fear, anger, and frustration of young people whose schools 
and neighborhoods are in the grip of an often deadly drug trade. They were 
heartened by the determination and commitment of teenagers striving to avoid 
the peer pressure to use and sell illicit drugs. At a town meeting that evening on 
“America’s Children and the Drug Crisis,” more than 500 citizens from across the 
metropolitan area turned out to express their concern over the threat that drugs 
and alcohol pose to children, adolescents, and families of all backgrounds and 
incomes. Many recovering addicts and alcoholics and their children told their 
own poignant stories of the consequences of parental substance abuse. 





OPENING DOORS FOR AMERICA'S CHILDREN 


Making Ends Meet: 


American Families 

and the Economy 

g Iver the past two decades, significant economic and social trends have dra- 

Charleston, West Virginia 

V_>^ matically altered the economic conditions of American families with chil- 

March 26, 1990 

dren. Stagnating wages for some categories of workers and the growing number 
of single-parent families have exerted a strong downward pull on median family 
income. In contrast, the entry and attachment of mothers to the paid labor force 
have bolstered the economic status of some families, especially those with two 
earners. Family incomes have also become less equally distributed in recent years. 
In particular, for single-parent families, young families with children, and two- 
parent families with a displaced worker, poverty has become more widespread. 

The dynamics of poverty differ depending on family composition. Among two- 
parent working families, poverty fluctuates widely from year to year and is highly 
dependent on wages and income. In contrast, poverty among single-parent fami¬ 
lies is generally sustained, and it reflects the vulnerability of having only one 
parent, usually a mother who is a low-wage earner, as the sole source of both 
economic support and nurturance. 

The effects of growing up poor are complex and not well understood. Recent 
studies indicate that child development reflects the intricate interaction of many 
factors present in a child’s home, school, neighborhood, and culture. While some 
of these influences support and enhance a child’s health and well-being, others 
endanger them. The balance between these protective and risk factors signifi¬ 
cantly affects child outcomes. 

Children growing up poor generally confront more risk factors and benefit 
from fewer protective or supportive factors than their more advantaged peers. A 
highly-stressed and disorganized family environment, limited access to health care 
and quality early childhood development programs, substandard housing and 
often dangerous neighborhoods, poor schools, and limited job prospects can all 
combine to place a low-income child in jeopardy of a lifetime of dependency and 
restricted opportunities. 

A wide-ranging public debate has ensued in recent years over the causes of 
poverty and ways to overcome it. One result is the Family Support Act, enacted by 
Congress in 1988 and now being implemented at the state level. The new law 
fundamentally changes the Aid to Families with Dependent Children (AFDC) 
program by strengthening work, education, or training requirements for most 
heads-of-households receiving public assistance; strengthening child support 
enforcement; and extending Medicaid and child care assistance during the tran¬ 
sition from welfare to work. Other policy options, including proposals to provide 


28 




OPENING DOORS FOR AMERICA’S CHILDREN 


Family 
Shrewsbury, 
West Virginia 


economic relief or assistance to low-income and working poor families through 
the tax code, continue to be discussed. 

In Charleston, West Virginia, the National Commission on Children explored 
the economic frustrations and challenges facing American families with children 
in a hearing on “Making Ends Meet: American Families and the Economy.” 
National experts presented different viewpoints and perspectives on the causes 
and consequences of childhood poverty and outlined an array of alternative 
solutions. Commissioners traveled to communities outside Charleston to visit 
families devastated by the decline of employment opportunities in manufacturing 
and mining and the failure of new industries to fill the employment void. In a 
forum with parents from Charleston and surrounding communities, Commis¬ 
sioners heard firsthand about the pride and determination — and sometimes the 
disillusionment — of parents who are struggling to make ends meet and to 
provide their children with a better life than they had themselves. 



29 















OPENING DOORS FOR AMERICA'S CHILDREN 


Emerging Themes and Issues 


Father and son 
Eskdale, 

West Virginia 


A t this interim stage, it is premature to offer even tentative recommenda¬ 
tions for future policy and program development. Over the coming year, 
the Commission will continue its investigation and deliberations to develop bold 
proposals for public and private sector action that the majority of Americans, 
regardless of political affiliation, can embrace. 

Nevertheless, several common themes and issues have emerged from the 
Commission’s hearings, town meetings, forums, focus groups, and site visits to 
date. They are presented here with the understanding that they will continue to 
evolve and develop as the study proceeds. 

The Critical Role of Parents and Other Caring Adults 

Families are and will remain the primary institution for childrearing in our 
society, just as parents are and will remain their children’s first and most impor¬ 
tant teachers, providers, and caregivers. The privilege of parenthood carries with 
it responsibility for the physical, social, and moral development of future genera¬ 
tions of Americans. 

These tenets concerning the intrinsic value of family life and the critical role 
of parents seem self-evident. Yet the dramatic social, demographic, and economic 
changes of the past two decades have fundamentally altered the roles and 
relationships between many parents and their children, as well as the routines of 
their daily lives. Throughout society, there is growing concern about the extent 
to which many parents are failing to fulfill their essential childrearing responsi¬ 
bilities. The rising number of female-headed families means that more and more 
children are growing up without the consistent presence of a father in their lives. 
The increase in mothers’ labor force participation means that many parents and 
children, even those in two-parent families, are spending less time together than 
either would like and perhaps need. And the rising number of births to young 
unmarried teenagers who lack the maturity, economic means, and parenting 
skills to care for themselves and their offspring means that a growing population 
of children is falling victim to a recurring cycle of poverty and hopelessness. 

While there are many expressions of sympathy and compassion for mothers 
struggling to raise children alone — and admiration for those who carry the 
double burden of sole breadwinner and caregiver — few would assert that it is 
easier or preferable for families to rear children without the involvement and 
support of both parents. Research on the dynamics of income and poverty 
indicates that the presence of two parents offers children substantial (though not 




Extended family 
Bennettsville, 
South Carolina 



absolute) protection from sustained poverty. At the same time, research on child 
development emphasizes the important and positive effects on children of close 
and lasting relationships with their fathers as well as their mothers. 

Many children are fortunate to have the love and support of their parents 
supplemented by warm and supportive relationships with other caring adults, 
including extended family members, teachers, religious leaders, professional 
service providers, and community volunteers. In communities large and small, 
caring adults frequently make the critical difference whether children fall be¬ 
tween the cracks and fail or whether they thrive and succeed. They make young 
people feel safe and special, provide guidance and strong role models, and offer 
encouragement and emotional support. Although these individuals can never 
supplant the essential role of parents, they can and do supplement and reinforce 
the care and nurturing provided by mothers and fathers. Unfortunately, however, 


32 





OPENING DOORS FOR AMERICA'S CHILDREN 


caring adults are not always available for those children who most need time and 
attention. The decline of volunteerism, government policies that discourage 
informal responses to individual and community needs, and the lack of resources 
to train and compensate qualified professionals are all cited as possible causes. 
Regardless of the cause, however, the result is that for many adults, children have 
declined as a priority. Yet there is growing recognition that as a societv we must 
find creative ways to restore the abilitv and willingness of parents and other caring 
adults to provide time and attention as well as financial resources that are essential 
to the health and well-being of America's children. 

Children in Poverty 

On average, U.S. children are economically better off in 1990 than they were 
in the 1960s, primarily because of rising family incomes through 1973 and the 
smaller number of children in most American families. Nevertheless, the eco¬ 
nomic profile of the average U.S. child does not capture the growing disparity 
among families with children. Levels of income and assets among minority 
children, though greater than in the 1960s, remain far below those of white 
children, especially for those in single-parent families. Overall, economic inequal¬ 
ity among children and their families has increased substantially over the past 
generation. 

Census data indicate that after steady and dramatic decreases in the 1960s, 
childhood poverty began to increase in the 1970s, peaking at 22 percent in 1983 
and remaining stubbornly above 20 percent to this day. The national rate, 
however, masks even more intense poverty in inner-city neighborhoods and some 
rural communities. .Almost one in three urban children and one in four rural 
children live in families whose incomes are below the poverty level. .Although 
poverty is not limited to any single group in societv, minority children are 
substantially more likely to grow up poor than are white children. Forty-five 
percent of black children and 39 percent of Hispanic children were poor in 1987, 
compared to 12 percent of white children. 

Increasingly, family structure is the chief determinant of whether a child will 
grow up in poverty. The children of single parents are five times as likely to be poor 
as children born to married couples. Today, more than half of all children living 
in single, female-headed households are poor. .Although children in two-parent 
families also experience poverty, marriage and the earnings of a male head-of- 
household are often a buffer against sustained economic disadvantage. 

Parental employment, however, does not always guarantee an escape from 
poverty. .Among poor, two-parent families, 44 percent have a full-year, full-time 
worker. .Another 25 percent have one or two adults who work at least part-time 




Young boy 
Chicago, Illinois 


or part of the year. Almost 40 percent of poor single mothers work at least part- 
time or part-year. In many respects, these working poor families face the harshest 
dilemma of all. Their incomes preclnde or seriously diminish welfare payments, 
food stamps, and other means-tested forms of public assistance. To the extent that 
a family’s Medicaid participation is pegged to eligibility to receive Aid to Families 
with Dependent Children, working poor families often have no health coverage, 
since many low-paying jobs do not include insurance benefits. For single mothers 
and two-earner families with low incomes, child care expenses can consume more 
than a third of their annual incomes. 

Traveling across the country, Commissioners met many children whose 
personal resilience and support from parents and other caring adults will shield 
them from the worst consequences of poverty. Nonetheless, poor children in 
America are in double jeopardy. They have the most health problems and the 
least access to care. They are growing up in families that experience the most 
stress, yet receive the least social support. They are at the highest risk of educa¬ 
tional failure, and often they attend the worst schools. They are in the greatest 


34 









OPENING DOORS FOR AMERICA’S CHILDREN 


danger of following paths that jeopardize their futures, yet they enjoy the fewest 
legitimate job opportunities. 

In addition to tremendous personal costs, childhood poverty imposes 
enormous long-term costs on the nation, threatening both our economic vitality 
and our democratic traditions. Industry leaders and small business owners alike 
express growing concern about the limited skills and potential of many new 
workers. The realization that a significant proportion of citizens will have neither 
the stake in society nor the education necessary to address the difficult issues that 
will confront the nation in years to come threatens the soul of a self-governing 
people. Moreover, the widening gap between rich and poor— and the increasing 
number of children at risk of repeating their parents' poverty — should enhance 
our resolve to make equal opportunity and the rewards of hard work a reality for 
all Americans. Abraham Lincoln’s admonition that a house divided cannot stand 
takes on a new but equally compelling meaning when viewed through the prism 
of a generation of children who have known sustained poverty. 


The Pervasiveness of Drugs 

Across the nation, the sale and use of illegal drugs have burst upon our 
national consciousness — both as a threat to children’s health and well-being and 
as a source of increasing crime, violence, and family dissolution. Commissioners 
visited neighborhoods and schools under a reign of terror imposed by powerful 
street gangs who control the drug trade and employ teenagers and even younger 
children. They confronted high school students who were angry that the respon¬ 
sible adults in their lives, including police, teachers, and parents, were unable or 
unwilling to protect them from danger and violence. They heard from young 
people who long for strong adult role models to help them resist the intense peer 
pressure to become a part of the drug culture and who beg for viable economic 
alternatives to the lure of easy drug money. And they were moved by the quiet 
courage of adolescents struggling to overcome alcohol and drug addictions. 

The devastating effects of drugs, especially crack cocaine, on the health and 
safety of American children and their families are readily apparent. Health crises 
such as elevated drug-related emergency room episodes, the high number of 
transmissions of the .AIDS virus associated with drug use, and the growing number 
of pregnant women abusing drugs have placed enormous strains on the nation's 
public health system. Violent crime and a thriving and ruthless drug economy tax 
the resources of the law enforcement and criminal justice systems. Alarming 
increases in child abuse and neglect resulting from parental substance abuse 


35 



Teenagers 
Chicago, Illinois 



threaten to overwhelm the already strapped child welfare systems of most states. 
And everywhere, treatment programs compete with prevention efforts for scarce 
financial resources. 

The nation’s anti-drug strategies are, to a large extent, still in a formative stage. 
Programmatic efforts vary widely from prevention and treatment to prosecution 
and interdiction, and many have yet to be rigorously evaluated. Across the 
country, policy discussions are characterized by vigorous debate over where and 
how to marshall public and private resources to achieve the greatest positive effect. 
Nevertheless, public officials, professionals, and parents alike agree on the 
urgency of the problems created by the escalating drug crisis and the need to find 
responsive solutions. 


36 






OPENING DOORS FOR AMERICA'S CHILDREN 


The Crisis in Health Care 

Throughout the nation, the health concerns of children and parents are 
painfully evident. In many rural communities and inner-city neighborhoods, 
health care providers are scarce, and their time, talents, and patience are 
stretched to the breaking point. At town meetings, forums, and site visits, Com¬ 
missioners met working parents who had no health insurance and children who 
have not received even the most basic preventive health care. City officials worried 
aloud over the desperate shortage of drug treatment programs — for anyone, but 
especially for pregnant women. 


Preschooler 
Coronado-Escobar 
Elementary School 
San Antonio, Texas 







OPENING DOORS FOR AMERICA’S CHILDREN 


The consequences of limited access told the most poignant story of all. Infant 
mortality rates are worse in many U.S. cities — where babies die at rates exceeding 
30 deaths per 1,000 live births — than in some developing nations. While Medicaid 
is an important means of health care financing, only about half of income-eligible 
children are covered. Less than half of the children eligible for preventive health 
care through Medicaid’s Early and Periodic Screening, Diagnosis and Treatment 
program actually receive services. The neonatal intensive care units of city 
hospitals are populated with a growing number of low birthweight babies, many 
born to mothers who received little or no prenatal care, and many who exhibit the 
tremors characteristic of drug exposure. Counseling and mental health services 
are often not available to children and youth until long after their problem 
behavior results in a crisis for themselves, their families, and their communities. 

In some cases, limited access goes hand-in-hand with poverty, especially for 
working poor families who do not receive employer-provided insurance, who are 
not eligible for Medicaid coverage, and who cannot afford private insurance 
premiums. In many states and cities, the combination of high malpractice 
premiums, a high-risk caseload, and below-market Medicaid rates discourages 
physicians from accepting publicly insured patients. In many rural communities, 
geographic isolation and the lack of transportation create additional barriers. 

Beyond geographic and financial barriers, however, are barriers imposed by 
the way health services are organized and by patients’ poor understanding of the 
importance of basic preventive health care. Parents and professionals highlight 
the need to deliver health services — particularly maternal and child health care 
and health education — in a context that recognizes other, often competing, 
needs of low-income, isolated, and highly stressed families. For parents living in 
substandard conditions, for example, the search for adequate housing or finding 
a way to put the next meal on the table may take precedence over a routine 
prenatal visit. This is particularly likely when an expectant mother perceives no 
problems with her pregnancy and keeping an appointment entails a several hour 
wait at a clinic that is open only during traditional working hours. 

Clearly, the health care crisis in this country extends well beyond the needs 
of children, affecting other segments of our population as well. But limited 
access — and its often dire consequences — is particularly troubling with respect 
to children and expectant mothers, since these are the populations for whom 
preventive care has been shown to be most effective and most cost-effective. 




Student 

Deputy Elementary 
School 

Deputy, Indiana 



The Need for School Readiness 

The results of a decade of attention to education reform are evident in many 
schools across the country'. From before- and after-school care and bilingual kin¬ 
dergarten, to parent education programs and Russian classes by satellite, creative 
and experimental approaches to expand children’s educational opportunities are 
burgeoning in large and small school systems, public and private, nationwide. 







































OPENING DOORS FOR AMERICA’S CHILDREN 


Renewed emphasis on basic skills training and stricter requirements for matricu¬ 
lation and graduation represent efforts to ensure that all students acquire essential 
literacy and problem-solving skills. 

Yet many fundamental lessons from years of research and programmatic ex¬ 
perience have not been fully incorporated into educational policy and practice. 
Significant in this regard is the continued absence of strong links between 
elementary schools and early childhood programs. Research indicates the impor¬ 
tance of preschool learning and socialization for school readiness and later school 
success. Nevertheless, only a fraction of the children who would benefit most from 
high quality early childhood programs have access to Head Start and other com¬ 
munity-based initiatives. Among the children with least access are those from low- 
income and highly-stressed families, those with disabilities, and those for whom 
English is not their first language. 

In order to learn, children must be healthy. They must be fed and rested and 
secure. Yet the population of young students who are entering the nation’s schools 
ill-prepared for the demands of formal education and at heightened risk of 
academic failure is growing rapidly because so many fail to get a healthy and 
secure start in life. Individual teachers often express concern about the complex 
lives and multiple needs of many of their students, as well as frustration over their 
limited ability to lend support. Equally disturbing is the failure of many school 


School children 
Charleston, 
West Virginia 



40 












Head Start student 
La Casa de Ninos 
Child Development 
Center 

San Antonio, Texas 


systems and education reform efforts to acknowledge or adapt to the circum¬ 
stances and special needs of this new, and frequently troubled, generation of 
young people. At a time when the conditions of many children’s lives call for 
increased flexibility, many school systems are becoming more rigid and less 
accommodating. There is little evidence that the educational system in most 
states and communities feels any kinship or common purpose with the health and 
social service systems, the community organizations, or the informal networks of 
support that also serve needy and troubled children and their families. 


41 










Pre-kindergarten 
class, Charles C. 
Ball School 
San Antonio, Texas 


Reorienting Services for Children: 

A Focus on Coordination and Prevention 

The present system of supports for children and families is an amalgam of 
public and private services and programs delivered by a diverse group of profes¬ 
sionals, paraprofessionals, and volunteers. It operates in a variety of settings and 
is financed by federal, state, local, or private funds, or by a combination of these 
sources. In many respects, this system reflects the diversity of American society 
and a traditional desire to limit state involvement in family life. In some instances, 
it has produced a rich, diverse, and extensive network of assistance to children and 
families. 

Nevertheless, a high degree of fragmentation discourages attention to the 
multiple and interrelated needs of many children and families, particularly those 
in low-income communities. Health care, mental health services, nutrition assis¬ 
tance, education, compensatory preschool, and other forms of support fre¬ 
quently operate in different locations and under different auspices. The design 


42 












OPENING DOORS FOR AMERICA'S CHILDREN 


and delivery of these services often reflect different (and sometimes conflicting) 
professional orientations, and the agencies that administer them may esponse dif¬ 
ferent missions. Yet in many cases they serve the same children. 

Time and again, the absence of coordination has led to costlv duplication and 
serious omissions. Parents attempting to locate services frequently confront cum¬ 
bersome and conflicting eligibility criteria and intake procedures, often they have 
to travel to different service delivery locations, and sometimes they receive contra¬ 
dictory information and direction. This labyrinth is at best discouraging and at 
worst denies help to parents and children in need. Yet coordination is easy to talk 
about but difficult to achieve. It raises complex financial, legal, and professional 

issues that will not be readilv resolved. 

/ 

In some cases programs serving children fail to reach out to and involve their 
families. Even though most children who receive services live in families, service 
providers often fail to recognize the significant role that parents and other family 
members can play in the short- and long-term effectiveness of prevention and 
treatment efforts. 

In addition, existing children’s services tend to emphasize the treatment of 
problems rather than their prevention. With notable exceptions, such as mater¬ 
nal and child health programs and Head Start, many services for children and 
families are problem-driven, with eligibility' triggered by a damaging incident, 
such as child abuse, or an identified condition, such as a physical or mental 
disability. Although prevention programs providing family support, parent edu¬ 
cation, and positive alternatives to drug use or teenage pregnancy exist, they are 
more often models of what ought to be than examples of what is common. 

The tradeoffs between prevention and treatment remain controversial. The 
reallocation of limited health and social service dollars is difficult in the face of 
individual children and families experiencing severe problems for which existing 
medical technology and clinical approaches offer predictable remedies. Broad- 
based prevention initiatives often do not yield immediate benefits even though 
they frequently hold the possibility of long-term savings in both human and 
financial terms. The old adage, “Pay now or pay later,” reflects the difficult and 
often value-laden assessment of current and future costs and benefits to children, 
their families, and society as a whole. 


43 









OPENING DOORS FOR AMERICA'S CHILDREN 


Opening Doors in the 1990s 


Student 
Sycamore Hills 
Elementary School 
Independence, 
Missouri 


T he 1990s present this nation with a rare combination of challenges and op¬ 
portunities. The social disorganization, poverty, crime, and hopelessness 
that grip many urban neighborhoods — and the new stranglehold of drugs — 
threaten to relegate whole groups of children to permanent second-class status. 
Health care financing and delivery are high on the agenda of national, state, and 
local officials, as families, employers, and health providers all struggle to improve 
a system that frequently fails to provide even the rudiments of basic care to many 
families with children. Corporate leaders warn with mounting urgency that our 
future prosperity and our status as a world economic power are threatened bv the 
declining skills and abilities of many graduates of American high schools — and 
by the virtual unemployability of those who fail to graduate. From many corners, 
there is growing recognition of the need for parents and other caring adults to 
devote time and attention as well as financial resources essential to children’s 
healthy growth and development. 

But there are also encouraging signs of public support for improving the 
future prospects of the nation’s children. In virtually every state in the union, 
school reform efforts, early childhood initiatives, and experimental health 
and social service programs are underway. As states continue to implement the 
Family Support Act, thev face choices that hold considerable promise for many 
poor children and parents. The shame of childhood poverty, the menace of 
drugs, and the crises in health care and education are increasingly uniting 
.Americans of different political persuasions in a concerted effort to develop far- 
reaching solutions. 

Members of the Commission have identified several emerging themes and 
issues in their review of the status of American children. Some, especially the 
critical importance of parents and caring adults in children's lives, offer consid¬ 
erable hope. Others, including childhood poverty, limited access to health care, 
and drug use, are complex and present difficult choices to policymakers and the 
public. Still others, especially those related to school readiness and to improving 
the delivery of services to children and families, are being addressed by policies 
and programs in states and localities across the country. 

Less than a year into its inquiry, this Commission is reluctant to offer prema¬ 
ture proposals. But the children and parents who shared their hopes, fears, and 
concerns are a constant reminder of how much is at stake. .As a democracy, an 
economy, and a compassionate society committed to liberty and justice, we suffer 




OPENING DOORS FOR AMERICA’S CHILDREN 


from the wasted talents and potential of even a single child. The doors of 
opportunity must be open to all children in this country. 

In one year, the National Commission on Children will announce its proposal 
for action on behalf of the nation’s children. It will be bold, and it will require the 
attention of every American. Moreover, it will almost certainly entail difficult 
choices about national priorities in an era of limited new public resources. But the 
tradeoffs are painfully clear to those who care to look. We can recognize the need 
to support our children and their families, or we can pay the higher moral and 
financial costs of continued decline and increasing polarization. 

As required by law, the Commission will report to Congress and the President. 
But it also will present a challenge to the nation — and a promise to our children. 


Young boy 
Shrewsbury, 
West Virginia 


46 





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OPENING DOORS FOR AMERICA’S CHILDREN 


Appendix: Commission Activities, September 1989 


March 1990 


HEALTHY MOTHERS AND 
HEALTHY BABIES 


Chicago, Illinois 
September 25, 1989 

Site Visits 

Neonatal Intensive Care Unit, 
Cook Count) Hospital 
Family Focus Lawndale 
Marillac House, Rockwell 
Gardens Project 
Winfield/Moody Health Center, 
Cabrini-Green 
Erie Family Health Center, 

West Town 

Hearing Witnesses 
Sarah Brown, Visiting Scholar, 
National Forum on the 
Future of Children and 
Families, Insutute of 
Medicine and the National 
Research Council, 
Washington, D.C. 

Judy Langford Carter, Executive 
Director, The Ounce of 
Prevention Fund, Chicago, 
Illinois 

Maureen Hallagan, M.S.W., 
Director of Project Hope, 
Marillac House, Chicago, 
Illinois 

Margaret Heagarty, M.D., 
Director of Pediatrics, 
Columbia University Harlem 
Hospital Center, New York, 
New York 

Patricia Johnson, Casefinder, 
Westside Future, 

Chicago, Illinois 
Richard Krieg, Ph.D., Acting 
Commissioner of Health, 
Chicago, Illinois 
Vivian Louis-Bumett, Casefinder, 
Westside Future, Chicago, 
Illinois 

Theresa Palmer, Parent and 
Marillac House Participant, 
Chicago, Illinois 
Rosita S. Pildes, M.D., Chairman. 
Division of Neonatology, 

Cook Count) Hospital, 
Chicago, Illinois 


Jack P. Shonkoff, M.D., Chief of the 
Division of Developmental 
and Behavioral Pediatrics, 
University of Massachusetts 
Medical School,Worcester, 
Massachusetts 

Reed V. Tuckson, M.D., Commissioner 
of Public Health, Washington, D.C. 


CHILDREN AND FAMILIES 
IN RURAL AMERICA. 

Part I: The Midwest 


Madison, Indiana 
October 12, 1989 

Town Meeting 

Madison Consolidated High School 


CHILDREN AND FAMILIES 
IN RURAL AMERICA 
Part II: The South 


Bennettsville, South Carolina 
February 15, 1990 

Forums and Focus Groups 
Focus group with incarcerated 
youth, Evans Correctional 
Institution 

Roundtable with the Interdenomi¬ 
national Ministerial Alliance, 
Shiloh Baptist Church 
Student forum, Marlboro Countv 
High School 

Roundtable discussion with rural 
health care providers, Marlboro 
Countv High School 

Town Meeting 
Marlboro County High School 


ENHANCING SCHOOL 
READINESS: SUPPORT FOR 
EARLY CHILDHOOD 
DEVELOPMENT 


San Antonio, Texas 
November 27-28, 1989 


Hearing Witnesses 
Barbara Bowman, Director of 
Graduate Studies, Erikson 
Institute, Chicago, Illinois 
Valerie Bryant, Parent. San .Antonio, 
Texas 

Peggy Cortez, Parent and Partici¬ 
pant in the Avance Program, 

San .Antonio, Texas 
Fernando Guerra, M.D., Director 
of Health. San .Antonio Metro¬ 
politan Health District, 

San .Antonio, Texas 
Sharon L. Kagan, Ed.D., .Associate 
Director, Bush Center in Child 
Development and Social Policv, 

Yale University, New Haven, 
Connecticut 

Ann Sanford, Director, Chapel Hill 
Training/Outreach Center; 
Co-Chair, North Carolina Inter¬ 
agency Coordinating Council for 
P.L. 99-457, Chapel Hill, North 
Carolina 

William Woodside, Chairman. 

Skv Chefs, Inc.; Vice Chairman. 
Committee for Economic 
Development; Former Chairman 
and CEO, Primerica Corporation, 
New York, New York 
Aletha Wright, Administrator. Office of 
Child Care Development, New 
Jersev State Department of Human 
Services, Camden, New Jersey 


AMERICA'S CHILDREN AND 
THE DRUG CRISIS 


Kansas City, Missouri 

December 11, 1989 

Site Visits 

Sycamore Hills Elementary School, 
Independence. Missouri 

Johnson County Adolescent Center 
for Treatment, Olathe, Kansas 

Forums and Focus Groups 

Student forum with high school students 
from the Kansas City, Missouri School 
District, Genesis School and De La Salle 
Education Center, John Thorn berry 
Unit of the Boys and Girls Clubs of 
Greater Kansas Citv 


MAKING ENDS MEET: 
AMERICAN FAMILIES AND 
THE ECONOMY 


Charleston, West ATrginia 
March 26, 1990 

Site Visit 

Home visits. Charleston and rural 
West A’irginia 

Forums, Focus Groups .and 
Discussions 
Meeting with state officials, 
Governor’s Mansion 
Parent forum, AAVGA of 
Charleston 

FIearing Witnesses 
Samuel Bonasso, Chairman. 
Governor’s Task Force on 
Children, Youth, and Families, 
Charleston. West A’irginia 
Honorable Gaston Caperton, 
Governor of West A’irginia, 
Charleston, West A’irginia 
David T. Ellwood, Ph.D., 

Professor of Public Policy, 

John F. Kennedy School 
of Government, Harv ard 
University, Cambridge, 
Massachusetts 
Lawrence M. Mead, Ph.D., 

.Assistant Professor of Politics, 
New York University, New 
York, New York 
Isabel V. Sawhill, Ph.D.. Senior 
Fellow, The Urban Institute, 
Washington, D.C. 

Sue H. Sergi, Executive Director, 
Community Council of 
Kanawha A'allev, Charleston, 
West Airginia 
Timothy M. Smeeding, Ph.D., 
Professor of Public Policv 
and Economics, A’anderbilt 
University, Nashville, Tennessee 
Terry Williams, Ph.D., 

Aisiting Scholar, Russell Sage 
Foundation, New York, 

New A’ork 


Site Visits 

Coronado-Escobar Elementary School 
Im Casa De Ninos Child Development 
Center 


Town Meeting 

Pierson Hall, University of Missouri- 
Kansas Citv 









OPENING DOORS FOR AMERICA’S CHILDREN 


Schedule of Events 


September 25, 1989 

Field Hearing 

Healthy Mothers and Healthy Babies 

Chicago, Illinois 

October 12, 1989 

Town Meeting 

Children and Families in Rural America 

Part I: The Midwest 

Madison, Indiana 

November 27 - 28, 1989 

Field Hearing 

Enhancing School Readiness: Support for Early Childhood Development 

San Antonio, Texas 

December 11, 1989 

Town Meeting 

America’s Children and the Drug Crisis 

Kansas City, Missouri 

February 15, 1990 

Town Meeting 

Children and Families in Rural America 

Part II: The South 

Bennettsville, South Carolina 

March 26, 1990 

Field Hearing 

Making Ends Meet: American Families and the Economy 

Charleston, West Virginia 

May 20 - 21, 1990 

Field Hearing 

Children in Between: The Middle Childhood Period 

Location to be announced 

May 31, 1990 

Field Hearing 

Children Outside Their Families 

Los Angeles, California 

July 2, 1990 

Field Hearing 

How Children Develop Values 

Washington, D.C. 

August 9-10, 1990 

(tentative date) 

Field Hearing 

High Risk Youth 

Location to be announced 

September, 1990 

(tentative date) 

Field Hearing 

Building a Productive Labor Force: The Transition from Education to Work 

Location to be announced 


6 ij 94 


48 







National Commission on Children 
1111 Eighteenth Street, N.W. 

Suite 810 

Washington, D.C. 20036 














































